Health

A study published last week found that robotic surgery is increasingly being used for women's hysterectomies, adding at least $2,000 to the cost without offering much benefit over less high-tech methods.

Dr. S. Mark Albini, chief of obstetrics and gynecology at Saint Mary's Hospital in Waterbury, doesn't dispute the study's finding that robotic surgeries are more expensive, but said it didn't go far enough to determine its actual benefits.

According to the Columbia University study, published Feb. 19 in the Journal of the American Medical Association, robotic surgery was used in just 0.5 percent of operations studied in 2007, but soared to almost 10 percent by early 2010. Columbia researchers analyzed data on more than 260,000 women who had their wombs removed at 441 U.S. hospitals for reasons other than cancer. The database covered surgeries performed through the first few months of 2010.

Women who had the robotic operations were slightly less likely to spend more than two days in the hospital, but hospital stays were shorter than that for most women. Also, complications were equally rare among robotic surgery patients and those who had more conventional surgeries. Average costs for robotic hysterectomies totaled nearly $9,000, versus about $3,000 for the least expensive method, a different type of minimally invasive technique using more conventional surgery methods.

TRADITIONALLY, hysterectomies were done by removing the womb through a large abdominal incision. Newer methods include removing the uterus through the vagina and minimally invasive "keyhole" abdominal operations using more conventional surgery methods, or surgeon-controlled robotic devices.

Robotic operations involve computer-controlled long, thin robot-like "arms" equipped with tiny surgical instruments. Surgeons operate the computer and can see inside the body on the computer screen, through a tiny camera attached to the robotic arms. The initial idea was for surgeons to do these operations miles away from the operating room, but robotic operations now are mostly done with the surgeon in the room.

Theoretically, robotic surgeries make it easier to maneuver inside the patient, and are increasingly used for many types of operations, not just hysterectomies.

The main explanation for the big increase "is that robotic surgery has been marketed extensively to not only hospitals and physicians, but also directly to patients," said Dr. Jason Wright, an assistant professor of women's health and the study's lead author. "There is minimal data in gynecology that it is advantageous."

ALBINI AGREES, but says the study should be put into greater context. Saint Mary's purchased its first robotic surgery equipment in 2010, and added a second system last November, making it one of just six hospitals statewide with two robotic surgical systems.

Albini says Saint Mary's now has the fourth-largest robotic surgery program in the state, and has done about 350 robotic hysterectomies since 2010. Almost have of those hysterectomies were robotic, he said.

Albini says study authors used limited data that may not reflect all of the complications that occurred following the surgeries.

"It didn't measure complications down the road, just that one incidence of care," Albini said.

The study also didn't look at each patient's weight, or the weight of the uterus, "which helps decide what route you take," Albini said. In his experience, he said, heavier patients see fewer complications and recover faster with robotic surgery.

The study also didn't look at each patient's prior surgical history, which could influence the type of procedure used.

Albini said surgeons who find it difficult to master the techniques of laparoscopic surgery have much more success using the robot.

"We've also seen doctors whose operating times have dropped when switching from laparoscopic to robotic," he said. "They can do more complex procedures in less time with the robot."

Reducing the time an incision is open reduces the chances for infection and complications from the surgery, Albini said.

The study notes that traditional abdominal hysterectomies remain common nationwide, and that more than 40 percent of the women studied had them, costing on average about $6,600.

While the study suggests there is a benefit to doing less-invasive procedures, it also suggests there is little difference between doing the procedure laparoscopically and using a more expensive robotic system.

Ultimately, Albini said, the study was good only as far as it went.

"If you have a narrow focus like they did, then you're going to get the results they got," he said. "If you look at everything in its entirety, you get a very different conclusion."

The Associated Press and Business Editor Dave Krechevsky contributed to this report.

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